85 research outputs found
An updated portrait of monocyte-macrophages in classical Hodgkin lymphoma
No full textClassical Hodgkin lymphoma (cHL) is a unique neoplastic ecosystem characterized by a heterogeneous immune infiltrate surrounding the rare malignant Hodgkin Reed-Sternberg cells. Though less abundant than T-cells, tumor-infiltrating macrophages play a pivotal role in supporting HRS survival through cell-to-cell and paracrine interactions. Traditional immunohistochemistry based upon the M1-M2 dichotomy yielded controversial results about the composition, functional role and prognostic impact of macrophages in cHL. More recent studies exploiting single-cell technologies and image analyses have highlighted the heterogeneity and the peculiar spatial arrangement of the macrophagic infiltrate, with the most immunosuppressive subpopulations lying in close proximity of HRS cells and the most tumor-hostile subsets kept far away from the neoplastic niches. High-throughput analysis of peripheral blood mononuclear cells in cHL patients have also identified a novel, potentially cytotoxic, subpopulation predicting better response to PD-1 blockade. This review examines the phenotypic profile, spatial localization and clinical impact of tumor-infiltrating macrophages and circulating monocytes in cHL, providing an up-do-date portrait of these innate immune cells with possible translational applications
Gallstone Ileus: An Unusual Cause of Small Bowel Obstruction: A Case Report
No full textGallstone ileus represents a rare complication of chronic cholelithiasis
and is considered a mechanical bowel obstruction caused by one or more
gallstones becoming lodged in the gastrointestinal tract. The etiology of
gallstone ileus is due to the transit of a calculum through a cholecystointestinal
fistula. In all cases of acute abdomen, diagnostic suspicion and appropriate first
surgical treatment are important for an adequate clinical progression due to
its low incidence. On other hand, due to the high incidence of gallstones, such
situations may arise in ordinary clinical practices, and clinicians should evaluate
gallstone ileus as a possible cause of bowel obstruction. However, because of
the poor general health of ileus patients, choosing an appropriate treatment is
challenging, and clinicians must make a decision on which surgery to perform.
We present a case of an elderly patient who presented to our emergency
department with gallstone ileus that received a prompt diagnosis and urgent
surgical resolution
Gastrointestinal Stromal Tumors of the Stomach: Is There Any Advantage of Robotic Resections? A Systematic Review and Meta-Analysis
No full textBackground: The role of robotic surgery for gastrointestinal stromal tumor (GIST) resection remains unclear. This systematic review and meta-analysis aimed to investigate the outcomes of robotic versus laparoscopic surgery in patients requiring surgery for gastric GISTs. Methods: MEDLINE, EMBASE, and the Cochrane databases were searched from inception to September 4, 2023. Two independent reviewers conducted a systematic review of the literature to select all types of analytic studies comparing robotic versus laparoscopic surgery for GISTs and reporting intraoperative, postoperative, and/or pathological outcomes. Results: Overall, 4 retrospective studies were selected, including a total of 264 patients, specifically 111 (42%) in the robotic and 153 (58%) in the laparoscopic group. Robotic surgery was associated with longer operating time (+42.46 min; 95% confidence interval [CI]: 9.34, 75.58; P=0.01; I2: 85%) and reduced use of mechanical staplers (odds ratio [OR]: 0.05; 95%CI: 0.02, 0.11; P<0.00001; I2: 92%;) compared with laparoscopy. Although nonsignificant, conversion to open surgery was less frequently reported for robotic surgery (2.7%) than laparoscopy (5.2%) (OR: 0.59; 95%CI: 0.17, 2.03; P=0.4; I2: 0%). No difference was found for postoperative and oncological outcomes. Conclusions: Robotic surgery for gastric GISTs provides similar intraoperative, postoperative, and pathological outcomes to laparoscopy, despite longer operative time
Successful Nonoperative Management (NOM) in Elderly Patients with Adhesive Small Bowel Obstruction (ASBO): a Cross-Sectional Analysis
No full textThe best treatment strategy for adhesive small bowel
obstruction (ASBO) in elderly patients is still a matter of
debate.[1]
If success with a nonoperative management (NOM)
allows the patient avoid the negative effects of perioperative
complications, NOM failure could lead to a significant delay
in surgical treatment, potentially causing a further depletion
of physiological reserves.[2,3]
Therefore, a comprehensive geriatric assessment is
always recommended to optimize the diagnostic and clinical
strategies in cases of ASBO.[1]
The present study was conducted to define predictive factors
for successful NOM in elderly patients (≥ 65 years)
presenting with ASBO at a tertiary emergency department
(ED)
Thermal gradient estimation with fiber-optic chirped FBG sensors: Experiments in biomedical applications
No full textThe measurement of short-scale (sub-millimeter) thermal gradients within 1-5 cm range can have a significant impact on several biomedical applications, including the measurement of effectiveness of thermal ablation, the estimation of blood pressure thermal differences during angioplasty, and fractional flow reserve. In this work, we propose and experimentally validate a technique to measure a thermal gradient with a fiber-optic sensor based on a linearly chirped fiber Bragg grating (LCFBG). The LCFBG spectrum is measured with a white-light setup, and a demodulation of the grating using the coupled mode theory model is used to estimate the thermal gradient. Experiments are reported in a calibration setup for a linear gradient, achieving <;1° C error, and in a laser ablation with a Gaussian-shaped thermal gradient
The Role of Surgery in the Management of Gastric Cancer: State of the Art
No full textSurgery still represents the mainstay of treatment of all stages of gastric cancer (GC). Surgical resections represent potentially curative options in the case of early GC with a low risk of node metastasis. Sentinel lymph node biopsy and indocyanine green fluorescence are novel techniques which may improve the employment of stomach-sparing procedures, ameliorating quality of life without compromising oncological radicality. Nonetheless, the diffusion of these techniques is limited in Western countries. Conversely, radical gastrectomy with extensive lymphadenectomy and multimodal treatment represents a valid option in the case of advanced GC. Differences between Eastern and Western recommendations still exist, and the optimal multimodal strategy is still a matter of investigation. Recent chemotherapy protocols have made surgery available for patients with oligometastatic disease. In this context, intraperitoneal administration of chemotherapy via HIPEC or PIPAC has emerged as an alternative weapon for patients with peritoneal carcinomatosis. In conclusion, the surgical management of GC is still evolving together with the multimodal strategy. It is mandatory for surgeons to be conscious of the current evolution of the surgical management of GC in the era of multidisciplinary and tailored medicine
Pressurized intraperitoneal aerosol chemotherapy with cisplatin and doxorubicin or oxaliplatin for peritoneal metastasis from pancreatic adenocarcinoma and cholangiocarcinoma
No full textBackground: Systemic chemotherapy for pancreatic adenocarcinoma (PDAC) and cholangiocarcinoma (CC) with peritoneal metastases (PM) is affected by several pharmacological shortcomings and low clinical efficacy. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is expected to maximize exposure of peritoneal nodules to antiblastic agents. This study aims to evaluate safety and efficacy of PIPAC for PM of PDAC and CC origin. Methods: This is a retrospective analysis of consecutive PDAC and CC cases with PM treated with PIPAC at two European referral centers for peritoneal disease. We prospectively recorded from August 2016 to May 2019 demographic, clinical, surgical, and oncological data. We performed a feasibility and safety assessment and an efficacy analysis based on clinical and pathological regression. Results: Twenty patients with PM from PDAC (14) and CC (six) underwent 45 PIPAC administrations. Cisplatin-doxorubicin or oxaliplatin were administered to eight and 12 patients, respectively. We experienced one intraoperative complication (small bowel perforation) and 18 grade 1-2 postoperative adverse events according to Common Terminology Criteria for Adverse Events version 4.0. A pathological regression was recorded in 50% of patients (62% in the cisplatin-doxorubicin cohort and 42% in the oxaliplatin one). Median survival from the first PIPAC was 9.7 and 10.9 months for PDAC and CC, respectively. Conclusion: PIPAC resulted feasible and safe without relevant toxicity issues, with both cisplatin-doxorubicin and oxaliplatin. The pathological response observed supports the evidence of antitumoral activity. Despite the study limitations, these outcomes are encouraging, recommending PIPAC in prospective, controlled trials in the palliative setting or the first line chemotherapy for PM from PDAC and CC
Dicevo di te, Elsa de' Giorgi : con un inedito di Pier Paolo Pasolini
No full textElsa de' Giorgi (1914-1997) viene quasi sempre ricordata come un'attrice teatrale e cinematografica della stagione dei telefoni bianchi, la moglie del conte Sandrino Contini Bonacossi, la scrittrice di svariati romanzi e, infine e soprattutto, l'amante, dal 1955 al 1958, di Italo Calvino. Alcuni - soprattutto gli appassionati del genere - non dimenticano di citare il noto "salotto letterario" che l'attrice aveva avviato nella sua abitazione romana dagli anni Cinquanta in avanti e che aveva visto l'avvicendarsi di artisti e intellettuali di primo piano del secondo novecento: da Emilio Cecchi a Carlo Levi, da Alberto Savinio a Pier Paolo Pasolini. Di quest'ultimo questo saggio contiene un inedito
Detection of thermal gradients through fiber-optic Chirped Fiber Bragg Grating (CFBG): Medical thermal ablation scenario
No full textIn this paper, we describe a novel method for spatially distributed temperature measurement with Chirped Fiber Bragg Grating (CFBG) fiber-optic sensors. The proposed method determines the thermal profile in the CFBG region from demodulation of the CFBG optical spectrum. The method is based on an iterative optimization that aims at minimizing the mismatch between the measured CFBG spectrum and a CFBG model based on coupled-mode theory (CMT), perturbed by a temperature gradient. In the demodulation part, we simulate different temperature distribution patterns with Monte-Carlo approach on simulated CFBG spectra. Afterwards, we obtain cost function that minimizes difference between measured and simulated spectra, and results in final temperature profile. Experiments and simulations have been carried out first with a linear gradient, demonstrating a correct operation (error 2.9 °C); then, a setup has been arranged to measure the temperature pattern on a 5-cm long section exposed to medical laser thermal ablation. Overall, the proposed method can operate as a real-time detection technique for thermal gradients over 1.5â5 cm regions, and turns as a key asset for the estimation of thermal gradients at the micro-scale in biomedical applications
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